...and somehow I misstep, each time.

Last week was a scheduled admission. It was canceled partway through because the school district, who'd already dicked around this family in terms of services, was refusing to pay for more than five hours a week schooling, as the kid had been on home tutoring for the past seven months. Threats of an education lawyer magically made them agree to summer school on the unit. So we have the kid come back today, thinking it's going to be easier to do the admission since we have the story already. It's an ODD/ADHD/PDD kid, daily or near-daily tantrums involving physical aggression to parents, teachers, peers, threats to kill others or himself when frustrated. Old hat as far as inpatient psych is concerned, and not as bad as some kids we've had on the unit by any means. He was toned down somewhat with a different stimulant, but still fairly aggressive and difficult to manage.

Now he's denied by his insurance company. They cite that this is a chronic problem, that the family needs respite, that a partial hospitalization is less restrictive and it's not acute enough to warrant admission. The doc to doc to appeal the denial upheld that. And if we admit the kid anyway, the family gets stuck with the astronomical bill. Hospitals ain't cheap; I remember hearing that adult psych is $1200-1500 per day. More if it's ECT. I have no idea if child is comparable or if it would be more because of the school on the unit.

I recognized the asshat's voice on the doc to doc, too. He denied another kid I had as not meeting the acuity. You know why? Because he was on a medical floor next to babies and the team bent over backward to make sure he didn't have an aggressive outburst. And ultimately we had to treat him on a consultant's basis and discharge him to residential. I did the initial consult back in February, and that kid went to residential last week.

Fuckers. Managed care sucks balls.

i cannot tell you how much i hate insurance companies, both as a practioner and as a patient. or in the current case, the policy holder.

Remember my joke about Indy the surgeon? Well, there were no less than three different attempts to get me to say that we have another insurance carrier to pay for this. Each time I've told my insurance carrier THERE IS NO OTHER INSURANCE CARRIER, BITCHES. Not to mention that at some point this summer i will have to prove that my husband is my husband and my daughter is my daughter. Not to mention, the hospital was in network but the attending that supervised the PA is not. We got slammed with a $532 bill for the dermabonding and cornea check, and only by bitching at my insurance carrier did they apologize and send me a check for that much to cover the cost.

And yesterday? Yet another letter from A SEPARATE COMPANY wanting to know if another carrier can pay for this fsking ER visit. I just left a voice mail message with my cell phone number telling them yet again that my insurance policy is the only one for the entire family.

As a doctor, I have the separate headache of calling for preauthorizations for meds or treatment or doing doc to docs to justify hospitalization. I have traitors to the profession pick apart my patient's symptoms and deny care because "it doesn't meet acuity."